How can i build parts of cheekbone scraped away

[Leon 007]

I had some Radiesse injectable filler injected on my right cheekbone to hide a small scar i had about three years ago.
The Radiesse caused a lump to appear and seemed quite apparant which made me self concious. I wanted to make the lump dissapear and i was going to have some steroids injected to help reduce the lump.
After hearing it was potentially dangerous i decided to approach my gp who forwarded me onto an nhs surgeon.
The nhs surgeon cut around the initial scar which was about 2 cm in length and 3 mm in width running vertically on my cheekbone. He then scraped away the lump which was a lump of tissue formed by the radiesse.
The lump was directly above my cheekbone and the surgeon scraped away the top part of my cheekbone as he was scraping the lump.
If i feel the left side cheekbone, the untouched cheekbone i can feel the cheekbone curves smoothly upwards onto the corner of my eye socket.
But on the right cheekbone where the surgeon scraped away the lump i can feel that the top part of my cheekbone doesnt have that curve because the top part of my cheekbone which runs to the corner of my eye socket feels more flat and i cant feel the plumpness of the bone, as its been scraped.away.

Also the surgery made my cheek muscles swell up and that puffy look hasnt gone my gp said it may be scar tissue in the cheek.

I was wondering is there any way i can build up the curve of the top part of my cheekbone as it doesnt look symmetrical is there any procedure out there that could give the top part of my cheekbone that slight curve?

Also how can i reduce the puffy look of the cheek muscles from the surgery?

Thankyou

[Archibald S Miller III, MD,FACS]

There is only one way to fix the problem you have and that is more surgery. You might have your own fat injected, or someone might smooth the area with a special file, and onlay a small implant. The puffiness you describe may be a problem that needs to be addressed with steroids or antibiotics. Go to an experienced plastic surgeon to see if he can help.

                     arch s miller ms md facs

[Leon 007]

Hi please can you answer these questions

How about injected radiesse into the area could i get an exact match as the other cheekbone, could this lead to further problems?

If i was to get fat grafts would it be a surgical operation or can that be injected?

Could bone graft be done to a good standard?

Regarding the pufiness could this be liquid (edema) trapped in the cheek and muscles?

If it is scar which i cant understand how scar tissue could have come about since the incision was made on the cheekbone, would it be ideal to get an mri scan could you see the scar tissue with this scan?

By injecting steroids directly onto the scar tissue in small doses could this lead to further problems, is there any other ways of reducing the scar tissue and pufiness in the cheek?

thanks

[Archibald S Miller III, MD,FACS]

Injecting steroids is a bad idea. The puffiness could be a reaction to the radiesse, and if you do the other side, you will repeat the problem. The fat injections can be done under heavy sedation, but one needs to inject local into the area of fat injection, so this may compromise your results. Bone grafts can be done, but they are usually done on both sides for larger defects. An MRI scan can be done, but it is likely the procedure will not be very helpful. You might get a CRP blood drawn to see if you have a chronic inflammation and this may help the diagnosis, but not help much with resolution. Sorry I cannot help much. I have chosen not to inject this product.

                                       arch s miller ms md facs

[Leon 007]

Hi just a few questions

What are the side affects of steroids if injected to a large are in the cheeks, what is the steroid is diluted and injected in small doses over a long period of time?

I dont think the pufiness is a reaction to the radiesse because i had the radiesse lump for 2 years on my cheekbone and didnt have any pufiness in the cheek, the pufiness occured directly from the surgery i had to cut around the existing scar on the cheekbone and have the lump scraped away.

Could the pufiness in the cheek be scar tissue or swelling and liquid that still exist in the cheek even a year after the surgery?

I understand for my case a fat transfer or a filler would be a better solution than bone graft to get that slight roundness and plumpness of the cheekbone.

I heard that a CT scan will be good to locate any scar tissue in the cheek causing the puffiness and slight steroid injections could help reduce the puffiness?

Sorry for my misunderstanding but what is a CRP and how can this help?

If it is chronic inflammation what steps can be taken to resolve the puffiness in the cheek, how will this not help with the resolution?

Sorry for all the questions but im trying to understand what it is so i can correctly go and sort this situation out, thankyou for your advice.

[Archibald S Miller III, MD,FACS]

Steroids make tissue atrophy, or shrink. You could end up with a worse problem. It can also result in color changes. The combination of the surgery and the radiesse may make the swelling happen. Or it could be a small fluid pocket, but an MRI will probably not be able to show a really small pocket. A CRP is a blood value that will show if you have a chronic inflammation as it will be elevated if it is. The area may have scar, a fluid pocket, chronic inflammation or all 3. You might try taking antibiotics and a solumedrol dose pak. This combination of antibiotics and an oral steroid might help.

                        arch s miller III ms md facs

[Leon 007]

Hi Dr i hope your ok sorry to keep asking questions, i find your answers are very helpful and i need to understand everything before i go and make any decisions, i know your advice doesnt account to a proper examination and i will be seeing some surgeons i hope you can answer my question please.

Well basically i want to add some plumpness and roundness to my cheekbone where it was scraped away.

The initial scar that was 3mm in width and 2cm in length that ran horizontically down my cheekbone was cut around and the filler was scraped out, then the skin would have been pulled about 3mm and stitched up.

I get a slight pulling sensation sometimes on the new scar now and i was wondering if i had some filler or fat transfer to give the cheekbone more roundness and plumpness could that affect the pulling sensation further as that area is filled up with filler, because slight skin was taken off?

Also could there be any further complications to the cheekbone area since scar tissue (3mm in width, 2cm in length) on the skin was slightly cut out and the skin stitched (scar revision)?

Have you heard of a filler called Teosyal, what would be the best filler for cheekbones in your opinion?

I understand that the filler must be injected deep enough next to the bone so it attaches itself on the cheekbone immitating cheekbone, is that correct, can this cause any further complications like the filler migrating?

Have you heard of a steroid called 5FU which is apparantly less riskier than other steroids that help break down scar tissue, what do you think of it?

Do you think it would be ideal for me to visit some dermatologist and dermatologist surgeon for the pufiness of the cheek area and cheekbone enhancement?

Is it possible i could email you some photo's to you?

[Archibald S Miller III, MD,FACS]

I would see a reconstructive plastic surgeon for the problems you describe. I would not use a dermatologist for a surgical problem . Plastic surgeons are trained to do both the cosmetic and reconstructive aspects. This doubles their experience and confidence level with problems as you describe. 5 FU is not a steroid, it is 5-fluoro-uracil, a chemotherapy agent that is commonly used cutaneously to treat skin cancers and to get rid of seborrheic keratoses. Do not allow anyone to inject into your body. It can make you very sick. I have not heard of teosyal, but that does not mean it is a bad agent. It simply means that not very people are using it, and it is probaly not FDA approved for the use you describe. The more surgery, injections and fillers you place in this area, the greater the possibility is you will make this problem worse. Please go to a reconstructive surgeon and get some sound advice along with a definitive examination.

                                     arch s miller ms md facs